There exists a wide range of specialty pharmaceuticals such as SYNAGIS® (MedImmune, Gaithersburg, Md.). In the case of SYNAGIS®, the specialty pharmaceutical is a unique injectable biologic. SYNAGIS® is one of the very few specialty pharmaceuticals that are used in all treatment settings: hospitals, doctors, home care companies. SYNAGIS® has to be administered by a health care professional. Consequently, it is not a self-administrable pharmaceutical. It is used on premature infants primarily and it is non-chronic. The premature infants who get the specialty pharmaceutical usually do so during the cold and flu season. Patients are treated roughly from October to March, depending on where they are in the United States and the terms and conditions of their payer policy. Once a patient has been subjected to a SYNAGIS® treatment regimen, they no longer require the specialty pharmaceutical in subsequent years. SYNAGIS® prevents a severe viral infection that in many cases can hospitalize a premature baby and in a very small number of cases, actually result in death. SYNAGIS® is a relatively high-cost specialty pharmaceutical in the pediatrics space. Assuming that a subject gets approximately five doses of SYNAGIS® in a treatment regimen, the cost for administration can be thousands of dollars.
The problem in the art that specialty pharmaceuticals such as SYNAGIS® presents are the widely varying conditions and circumstances under which insurance covers each patient for such drugs. In many instances, an insurance plan may not cover certain products. And, while in most instances insurance plans do cover specialty pharmaceutical such as SYNAGIS®, the conditions under which each such insurance plan covers such drugs widely varies. For instance, the patient selection criteria vary from insurance payer by insurance payer. Additionally, in the case of SYNAGIS®, the season length varies by region of the country and by payer policy. Furthermore, in the case of SYNAGIS®, because it is a pediatric specialty pharmaceutical, each and every year pediatricians must identify and qualify an entirely new patient pool. Another complication associated with drugs, such as SYNAGIS®, is that specialty pharmacy distributors supply them. In the United States, there are several hundred such distributors that distribute specialty pharmaceutical such as SYNAGIS®.
A specialty pharmacy distributor has functionality equivalent to a mail order center, only for high-cost biologics. To order a specialty pharmaceutical for a patient, a physician has to complete a form and send it the specialty pharmacy. The form is typically one sheet long and includes information pertaining to identification of the patient, the patient's insurance, and the patient's clinical circumstances. The form as a practical matter serves two functions. First, it serves to provide the specialty pharmacy with information to get the product preauthorized by the payer, and second, assuming the patient qualifies, it serves as a prescription by which the pharmacy can then legally dispense the drug. Presently, over the course of the specialty pharmaceutical's life, all this is done on paper and by Fax. This conventional practice, while functional, is unsatisfactory. Often, the paper forms are incomplete or illegible, which means that the specialty pharmacy that receives the form has to contact the physician's office for additional clinical information, additional demographic or insurance information, or quite literally to understand what the doctor wrote on the form. Conversely, physicians are faced with the problems of (i) identifying a suitable specialty pharmacy that sells the specialty pharmaceutical to send the forms to and (ii) determining what information is required by such a specialty pharmacy. As indicated above, given the widely varied requirements of the insurance plans that cover the products such as SYNAGIS®, coupled with the varied rules and procedures of the numerous specialty pharmacists that sell such products, there is no uniformity in the information required by specialty pharmacies.
Moreover, adding to the complexity in ordering specialty pharmaceuticals, because of their relatively high costs and the widely varying conditions under which insurance companies authorize their use, physician requests for such drugs are scrutinized and, in some instances, denied. When a request is denied, a physician may appeal the denial. As in the case of ordering the specialty pharmaceutical in the first place, the appeal process varies from insurance company to insurance company.
In the art, there exists e-prescribing software and hardware that electronically transfers prescription information. E-prescribing is useful in situations where a doctor wishes to send a request electronically to a pharmacy without having to provide a written script to the patient. This is advantageous for several reasons, including the elimination of problems that arise from handwriting legibility, the convenience to the pharmacist, and to the patient. For instance, rather than hand delivery a script to the pharmacists and then waiting for up to an hour for the prescription to be filled, the prescription can already be filled when the patient arrives at the pharmacists. The United States government has supported e-prescribing initiatives and it has met an enthusiastic response in the medical community. However, e-prescribing is not in widespread use to date. Moreover, with respect to specialty pharmaceuticals, known e-prescribing systems do not have a mechanism for providing additional clinical information with the request for a prescription. Thus, known e-prescribing systems fail to provide any kind of information for drugs that might require prior authorization from insurance provider. As a consequence, e-prescribing is limited to common pharmaceuticals that don't require prior clinical-based review by the insurance provider prior to authorization. Additionally, there are systems used by vendors that will store and convey insurance information or patient demographics. However, such systems do not have means for attaching a prescription.
Given the above background, what is needed in the art are improved systems and methods for ordering specialty pharmaceuticals.